DOH Program: Maternal & Family Planning PDF

DOH PROGRAM  THE MATERNAL HEALTH PROGRAM THE PHILIPPINES IS TASKED TO REDUCE THE MMR BY THREE QUATERS BY 2015 TO ACHIEVE ITS MILLENIUM DEVELOPMENT GOAL. THE NATIONAL SAFE MOTHERHOOD PROGRAM PRIMARILY FOCUSES ON THE HEALTH AND WELFARE OF WOMEN THROUGHOUT THEIR PREGNANCY....

DOH PROGRAM  THE MATERNAL HEALTH PROGRAM THE PHILIPPINES IS TASKED TO REDUCE THE MMR BY THREE QUATERS BY 2015 TO ACHIEVE ITS MILLENIUM DEVELOPMENT GOAL. THE NATIONAL SAFE MOTHERHOOD PROGRAM PRIMARILY FOCUSES ON THE HEALTH AND WELFARE OF WOMEN THROUGHOUT THEIR PREGNANCY. IT ALSO INCLUDES THE ADOLESCENT PREGNANT AND MEETING THE UNMET NEEDS FOR FAMILY PLANNING CONTRACEPTIVES OF WOMEN INTO ITS PRIORITY AGENDA UNTIL 2030. WHAT ARE THE CAUSE OF MATERNAL DEATH?  DELAY IN TAKING CRITICAL ACTIONS  DELAY IN SEEKING CARE  DELAY IN MAKING REFERALS  DELAY IN PROVIDING APPROPRIATE MEDICAL MANAGEMENT  THE MATERNAL HEALTH PROGRAM WHAT ARE THE OTHER FACTORS THAT CONTRIBUTES TO MATERNAL DEATH? DEATH INCLUDING CLOSELY SPACED BIRTHS FREQUENT PREGNANCY POOR DETECTION AND MANAGEMENT OF HIGH RISK PREGNANCIES POOR ACCESS TO HEALTH FACILITIES BROUGHT ABOUT BY GEOGRAPHIC DISTANCE LACK OF HEALTH STAFF AND COMPETENCE OF THE HEALTH STAFF WHAT HAS THE GOVERNMENT DONE TO ADDRESS THIS PROBLEM? BEMOC STRATEGY (BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE) IMPROVE THE QUALITY OF PRENATAL AND POSTNATAL VISIT REDUCE WOMEN’S EXPOSURE TO HEALTH RISK THROUGH INSTITUTIONALIZATION OF RESPONSIBLE PARENTHOOD. LGUS AND NGOS AND OTHER STAKEHOLDER MUST ADVOCATE FOR HEALTH THROUGH RESOURCE GENERATION  THE MATERNAL HEALTH PROGRAM ESSENTIAL HEALTH SERVICES PACKAGES AVAILABLE IN THE HEALTH CARE FACILITIES A. ANTENATAL REGISTRATION: B. TETANUS TOXOID IMMUNIZATION C. MICRONUTRIENTS SUPPLEMENTATION D. TREATMENT OF DISEASE AND OTHER CONDITION E. CLEAN AND SAFE DELIVERY THE MATERNAL HEALTH PROGRAM CLEAN AND SAFE DELIVERY DO A QUICK CHECK UPON ADMISSION FOR EMERGENCY SIGNS: UNCONCIOUS/ CONVULSION VAGINAL BLEEDING SEVERE ABDOMINAL PAIN LOOKS VERY ILL SECERE HEADACHE WITH VISUAL DISTURBANCE SEVERE BREATHING DIFFICULTY FEVER SEVERE VOMITING MAKE THE WOMAN COMFORTBALE ASSESS THE WOMAN IN LABOR  DETERMINE THE STAGE OF LABOR DECIDE IF THE WOMAN CAN DELIVER SAFELY GIVE SUPPORTIVE CARE THROUGHOUT LABOR ENCOURAGE TO TAKE A BATH ENCOURAGE TO DRINK ENCOURAGE TO EMPTY THE BLADDER ENCOURAGE TO DO BREATHING TECHNIQUES MONITOR AND MANAGE LABOR MONITOR CLOSELY WITHIN ONE HOUR AFTER DELIVERY AND GIVE SUPPORTIVE CARE CONTINUE CARE AFTER ONE HOUR POSTPARTUM EDUCATE AND COUNSEL ON FP AND PROVIDE FP METHOD INFORM , TEACH AND COUNSEL THE WOMEN ON IMPORTANT MCH MESSAGE BIRTH REGISTRATION IMPORTANCE OF BF NBS SCHEDULE OF VISIT FOR POSTPARTUM VISIT B. TETANUS TOXOID AND DENTAL CHECK UP CONTROVERSIAL ISSUE--HAS SOME ABORTIVE PROPERTY, THUS GIVING IT TO PREGNANT WOMEN WAS DISCOURAGED. HOWEVER, AN ADMINISTRATIVE ORDER (AO 15) - REINSTITUTION OF THE TETANUS TOXOID, BUT IT SHOULD DE GIVEN TO WOMEN WHO ARE ON THERE 5TH MONTH OF PREGNANCY TO AVOID ABORTION. ADMINISTRATION OF TETANUS TOXOID ON PREGNANT WOMEN: TT1 - 5TH MONTH OF PREGNANCY TT – TETANUS TOXOID TT2 - AFTER 4 WEEKS TT1 – NO PROTECTION YET TT3 - 6 MONTHS AFTER TT2 – 3 YEARS PROTECTION TT4 - 1 YEAR AFTER TT3 TT3 – 5 YEARS PROTECTION TT5 - 1 YEAR AFTER TT4 TT4 – 10 YEARS PROTECTION TT5 – LIFETIME PROTECTION TETANUS TOXOID IMMUNIZATION: ADMINISTRATIVE ORDER (AO 15)- REINSTITUTION OF THE TETANUS TOXOID, BUT IT SHOULD DE GIVEN TO WOMEN WHO ARE ON THERE 5TH MONTH OF PREGNANCY TO AVOID ABORTION. IF A MOTHER HAS RECEIVED 2 DOSES OF TETANUS TOXOID IMMUNIZATION, SHE IS CONSIDERED FULLY IMMUNIZED MOTHER (FIM) RELATIONSHIP OF TT DOSE & DURATION OF PROTECTION  THREE CLEANS TO BE PRACTICED IN DELIVERY: 1. CLEAN HANDS 2. CLEAN DELIVERY SURFACE 3. CLEAN CUTTING AND DELIVERY AND CARE OF THE UMBILICAL CORD. *SYNTOCINON RATHER THAN METHERGIN AFTER THE BABY HAS BEEN BORN SYNTOCINON MAY BE GIVEN TO STIMULATE CONTRACTIONS THAT HELP PUSH OUT THE PLACENTA AND PREVENT HEAVY BLEEDING ALSO SOMETHING TO DO WITH THE FIRST FLOW OF MILK. 3. VITAMIN A – FOR PREGNANT WOMAN. DOSAGE - 10 000 IU (3 TIMES A WEEK UP TO TERM STARTING ON THE 4TH OR 5TH MONTH)IF TAKING MULTIVITAMINS DO NOT GIVE VITAMIN A. VITAMIN A ENHANCES THE ABSORPTION OF IRON TOWARDS THE BONE MARROW. 5. CHLOROQUINE - ALTHOUGH NOT ROUTINELY GIVEN TO PREGNANT WOMEN, IT IS USED TO TREAT MALARIA. CAN BE GIVEN TO WOMEN IN ENDEMIC AREAS, 2 TABLETS PER WEEK QUICKLY UP TO THE DURATION OF THE PREGNANCY. TREATMENT: CHLOROQUINE (SAFE FOR PREGNANT WOMEN) - BEFORE GOING TO A PLACE WHERE MALARIA IS PREVALENT. * CHLOROQUINE - 1 TABLET A WEEK FOR TWO (2) WEEKS - WHEN ALREADY IN THE PLACE: * CHLOROQUINE - 1 TABLET A WEEK FOR FOUR (4) WEEKS - WHEN YOU ARRIVED AT YOUR PLACE: * CHLOROQUINE - 1 TABLET A WEEK FOR TWO (2) WEEKS 6. CALCIUM - GIVEN ANYTIME, 500MG ONCE A DAY, FOR BONE RESORPTION, BECAUSE THE BABY GETS THE CALCIUM OF THE MOTHER. BONE RESORPTION IS THE PROCESS BY WHICH OSTEOCLASTS BREAK DOWN BONE AND 7. FOLIC ACID – DOSAGE: 500MG ONCE A DAY FOR IRON ABSORPTION PREVENTS NEURAL TUBE DEFECTS (DEFECT IN THE SPINAL CORD - SPINA BIFIDA) TBA - TRADITIONAL BIRTH ATTENDANT (ALSO KNOWN AS “HILOT”) UNDER PRESIDENTIAL DECREE 651. - HILOT ARE ALLOWED TO DO DELIVERY PROVIDED THEY WILL REPORT THE DELIVERIES THEY PERFORMED TO THE NEAREST HEALTH CARE UNIT. PD. #651 - MANDATES THAT WHOEVER PERFORMS THE DELIVERY MUST REGISTER THE BIRTH WITHIN 30 DAYS. A QUALITY ANTE NATAL CHECK-UP IS WHERE A PREGNANT WOMAN GETS TO HAVE AT LEAST ONE CHECK-UP EVERY TRIMESTER. HIGH RISK PREGNANCIES:  TOO YOUNG – LESS THAN 18 YRS. OLD  TOO OLD - MORE THAN 34 YEARS OLD  TOO MANY – MORE THAN 4 CHILDREN  TOO CLOSE – LESS THAN 3 YEARS INTERVAL  GETTING PREGNANT WHILE SICK WITH CHRONIC DISEASES LIKE TB OR MALARIA OR WITH IRON DEFICIENCY. POST NATAL CARE: NURSING CARE AFTER DELIVERY THE CORD MUST BE CUT BETWEEN TWO CLAMPS OR TIED USING CLEAN AND A STERILE SCISSORS OR BLADE. THEN THE BABY IS IMMEDIATELY PUT TO MOTHER’S BREAST. THE MOTHER MUST BE CLOSELY WATCHED DURING THE FIRST TWO HOURS AFTER DELIVERY FOR BLEEDING. THE FOLLOWING MUST BE CHECKED:  MOTHER  THE UTERUS IS CONTRACTED AND HARD  BLOOD PRESSURE AND PULSE RATE MUST BE NORMAL  PLACENTA MUST BE COMPLETELY EXPELLED  LACERATION ALONG BIRTH CANAL BABY  VITAL SIGN/REFLEXES WITH USE OF APGAR SCORING 7-10- HEALTHY BABY 5-6 – BABY MILDLY DEPRESSED 4 BELOW – SEVERELY DEPRESSED, BABY LIKELY TO DIE  MIDWIVES SHOULD BE MADE AWARE OF THE DELIVERIES ATTENDED BY TRADITIONAL BIRTH ATTENDANT(TBA). THEY MUST SEE TO IT THAT THESE DELIVERIES MUST BE REPORTED BY THE TBAS TO THE NEAREST HEALTH FACILITY FOR PURPOSE OF CONTINUING SERVICE.  EACH BABY MUST BE REGISTERED AT THE CIVIL REGISTRY. THE BIRTH CERTIFICATE SHOULD BE FILLED UP BY THE ATTENDANT AT BIRTH (IF IT IS A HILOT, SHE/HE HAS TO BE HELPED IN FILLING –UP AND REGISTERING BY THE MIDWIFE).  ALL NEWBORNS SHOULD BE ENROLLED FOR UNDER FIVES AND SHOULD BE ISSUED S GROWTH MONITORING CHART.  FOR HOME DELIVERIES, THE FIRST POSTPARTUM VISIT SHALL BE DONE 24 HOURS AFTER DELIVERY; THE NEXT VISIT SHALL BE AT LEAST ONE WEEK AFTER DELIVERY, THE THIRD VISIT TWO TO FOUR WEEKS THEREAFTER. THE VISIT TO THE HEALTH FACILITY SHALL BE WITHIN FOUR TO SIX WEEKS AFTER DELIVERY. THE FOLLOWING ARE QUALIFIED FOR HOME DELIVERY: 1. FULL TERM 2. LESS THAN 5 PREGNANCIES 3. CEPHALIC PRESENTATION 4. WITHOUT EXISTING DISEASE SUCH AS DIABETES, BRONCHIAL ASTHMA, HEART DISEASE, HYPERTENSION, GOITER, TUBERCULOSIS, SEVERE ANEMIA 5. NO HISTORY OF COMPLICATION LIKE HEMORRHAGE, DURING PREVIOUS DELIVERIES 6. NO HISTORY OF DIFFICULT DELIVERY AND PROLONG LABOR (MORE THAN 24 HRS FOR PRIMIGRAVIDAS AND MORE THAN 12 HOURS FOR MULTIGRAVIDAS). 7. NO PREVIOUS CAESARIAN SECTION 8. IMMINENT DELIVERIES 9. NO PREMATURE RUPTURE OF MEMBRANES (BOW) 10. ADEQUATE PELVIS 11. ABDOMINAL ENLARGEMENT IS APPROPRIATE FOR AGE GESTATION THE FAMILY PLANNING PROGRAM FAMILY PLANNING (FP) IS HAVING THE DESIRED NUMBER OF CHILDREN AND WHEN YOU WANT TO HAVE THEM BY USING SAFE AND EFFECTIVE MODERN METHODS. PROPER BIRTH SPACING IS HAVING CHILDREN 3 TO 5 YEARS APART, WHICH IS BEST FOR THE HEALTH OF THE MOTHER, HER CHILD, AND THE FAMILY. THE OVERALL GOAL OF FP IS TO PROVIDE ACCESS TO FAMILY PLANNING INFORMATION AND SERVICES WHEREVER AND WHENEVER THESE ARE NEEDED FP AIMS TO: REDUCE INFANTS' DEATHS NEONATAL DEATHS UNDER – FIVE DEATHS MATERNAL DEATHS STRATEGIES OF FP: FOCUS SERVICE DELIVERY TO THE URBAN AND RURAL POOR REESTABLISH THE FP OUTREACH PROGRAM STRENGTHEN FP PROVISION IN LEGIONS WITH HIGH UNMET NEEDS PROMOTE FRONTLINE PARTICIPATION OF HOSPITALS MAINSTREAM MODERN NATURAL FP PROMOTE AND IMPLEMENT CSR (CORPORATE SOCIAL RESPONSIBILITY) STRATEGY FOUR PILLARS OF FAMILY PLANNING: RESPONSIBLE PARENTHOOD RESPECT FOR LIFE BIRTH SPACING INFORMED AND VOLUNTARY CHOICE BENEFITS OF USING FAMILY PLANNING: MOTHER  ENABLES HER TO REGAIN HER HEALTH AFTER DELIVERY.  GIVES ENOUGH TIME AND OPPORTUNITY TO LOVE AND PROVIDE ATTENTION TO HER HUSBAND AND CHILDREN.  GIVES MORE TIME FOR HER FAMILY AND OWN PERSONAL ADVANCEMENT.  WHEN SUFFERING FROM AN ILLNESS, GIVES ENOUGH TIME FOR TREATMENT AND RECOVERY. CHILDREN  HEALTHY MOTHERS PRODUCE HEALTHY CHILDREN.  WILL GET ALL THE ATTENTION, SECURITY, LOVE, AND CARE THEY DESERVE. FATHER  LIGHTENS THE BURDEN AND RESPONSIBILITY IN SUPPORTING HIS FAMILY.  ENABLES HIM TO GIVE HIS CHILDREN THEIR BASIC NEEDS (FOOD, SHELTER, EDUCATION, AND BETTER FUTURE).  GIVES HIM TIME FOR HIS FAMILY AND OWN PERSONAL ADVANCEMENT. FAMILY PLANNING METHODS: PERMANENT METHOD  TUBAL LIGATION  VASECTOMY NATURAL METHOD  BASAL BODY TEMPERATURE CHARTING  CALENDAR CALCULATION - PREDICTS THE FERTILE PERIOD BY MENSTRUAL DATING CERVICAL MUCUS MONITORING WHAT IS LAM? BY FEEDING A NEW BABY ONLY WITH BREAST MILK, A NEW MOTHER CAN PREVENT PREGNANCY FOR UP TO SIX MONTHS IF HER PERIOD HAS NOT RETURNED. WHEN USED AS A FAMILY PLANNING METHOD, THIS PATTERN OF EXCLUSIVE BREASTFEEDING IS CALLED THE LACTATIONAL AMENORRHEA METHOD, OR LAM. THREE (3) MATERNAL REFLEXES IN BREASTFEEDING: 1. MILK SECRETING REFLEX - DURING PREGNANCY THERE IS A DECREASE IN PROLACTIN BECAUSE THERE IS AN INCREASE IN PROGESTERONE. 2. LET-DOWN - OXYTOCIN IS RELEASE BY THE POSTERIOR PITUITARY GLAND. 3. MILK EJECTING REFLEX - BROUGHT BY OXYTOCIN. BREASTFEEDING RELEASES THE HORMONES OXYTOCIN AND PROLACTIN. THESE RELAX THE MOTHER AND MAKE HER FEEL MORE NURTURING TOWARD HER BABY. BREASTFEEDING SOAR AFTER GIVING BIRTH INCREASES OXYTOCIN LEVELS IN THE ARTIFICIAL OR TEMPORARY METHOD: 1. BARRIER METHOD - OF BIRTH CONTROL PHYSICALLY STOP THE SPERM FROM GETTING TO THE EGG. CONDOMS A. MALE CONDOMS – 15% SAFE BUT 2%IF USED PERFECTLY B. FEMALE CONDOM – A THIN POLYURETHANE BARRIER TYPICALLY 21% BUT 5% IF USED PERFECTLY DIAPHRAGM – DOME SHAPED FITS INSIDE THE VAGINA OVER THE CERVIX. 16% BUT CAN BE 6% IF USING SPERMICIDE AND FOLLOWING INSTRUCTION PROPERLY. MUST BE LEFT IN PLACE 6 HOURS AFTER SEXUAL INTERCOURSE. 2. LONG ACTING REVERSIBLE CONTRACEPTIVES – LAST FOR A LIFETIME INTRA UTERINE DEVICE (IUD) – SMALL DEVICE PUT BY THE HEALTH CARE PROVIDER, THICKENS MUCUS IN CERVIX, 1% IN GETTING PREGNANT, CAN STAY FOR 5 YEARS PILLS 2 KINDS: COMBINED PILL – PILLS MADE OF TWO HORMONES, ESTROGEN AND PROGESTERON, STOPS OVARIES FROM RELEASING EGG, TYPICALLY 8% BUT 1% IF USED PERFECTLY, SHOULD NOT BE USED BY WOMAN OVER 35 YRS OLD AND WHO SMOKE. VAGINAL RING  NUVA RING, CONTAINS TWO HORMONES ESTROGEN AND PROGESTERON  SITS INSIDE THE VAGINA  STOPS OVARIES FROM RELEASING EGG  TYPICALLY 8% BUT 1% IF USED PERFECTLY, LASTS FOR 3 -4 WEEKS  SHOULD NOT BE USED BY WOMEN OVER 35 YRS OLD WHO SMOKE MISCONCEPTION ABOUT FP:  SOME FP METHODS CAUSES ABORTION  USING CONTRACEPTIVES WILL RENDER COUPLES STERILE.  USING CONTRACEPTIVES METHODS WILL RESULT TO LOSS OF SEXUAL DESIRE ROLES OF PHN ON FP PROGRAM:  PROVIDE COUNSELING AMONG THE CLIENTS WILL HELP INCREASE FP ACCEPTORS AND AVOID DEFAULTERS.  PROVIDE PACKAGES OF HEALTH SERVICES AMONG REPRODUCTIVE AGE GROUP IN ALL HEALTH FACILITIES.  ENSURE THE AVAILABILITY OF FP SUPPLIES AND LOGISTIC FOR THE CLIENT.